# Triple Infectious Syndrome: Pulmonary Tuberculosis and HIV in a Case of Pure Neuritic Leprosy With Underlying Diabetes Mellitus

## TL;DR

A rare case of a patient with three infections—pulmonary tuberculosis, HIV, and leprosy—highlights complex diagnosis and treatment challenges.

## Contribution

This case report emphasizes the rare co-occurrence of PTB, HIV, and leprosy and the challenges in managing drug interactions and stigma.

## Key findings

- Co-infection with PTB, HIV, and leprosy is rare but poses significant treatment challenges.
- Drug interactions and toxicities complicate therapeutic optimization in such cases.
- Psychological support is essential due to the social stigma associated with these diseases.

## Abstract

Pulmonary tuberculosis (PTB), human immunodeficiency virus (HIV), and leprosy are of public health importance, as all three diseases are communicable and contribute to disease burden in society. Co-infection with these three entities is extremely rare but leads to significant mortality and morbidity. We report a case that highlights the diagnostic challenges and therapeutic management of a patient who was diagnosed with pure neuritic leprosy on multibacillary-multidrug therapy (MB-MDT) and subsequently co-diagnosed with PTB and HIV. The patient was started on anti-tubercular therapy and anti-retroviral therapy for treatment under India’s national health programs, which play a major role in treating those of low socioeconomic status. The optimization of these therapeutic drugs is quite challenging during treatment due to potential drug interactions and toxicities. High clinical suspicion is required to rule out PTB before initiating rifampicin-containing MB-MDT, which can lead to rifampicin-resistant TB and screening for HIV. As there is a social stigma associated with these patients, they require good psychological support during and after treatment.